Modifiers

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Author:
Chum
ID:
163917
Filename:
Modifiers
Updated:
2012-07-25 11:29:51
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modifiers
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Description:
mods
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  1. 22
    Unusual procedural service


    Used when the service provide is greater than that usually required for the listed procedure
  2. 24
    Unrelated E&M by the same physician during the post-op period


    E&M Service performed during the post-op period is unrelated to the original procedure
  3. 25
    Significant, separately identifiable E&M by the same physician on the same day as procedure or other service


    On the day that the procedure is performed, the patient’s condition warranted a separate E&M beyond the usual pre-op care associated with the procedure
  4. 26
    Professional component


    Certain procedures have both a professional and technical component
  5. 50
    Bilateral procedure


    Used when the same procedure is performed on both sides of the body at the same operative session
  6. 51
    Multiple procedures


    Used when multiple surgeries are performed at the same operative session
  7. 52
    Reduced services


    When a service or procedure is partially reduced or eliminated at the physician’s discretion
  8. 57
    Decision for surgery


    Used to indicate that an E&M service resulted in the initial decision to perform the surgery
  9. 58
    Staged or related procedure by same physician during the post-op period


    Physician must document that the performance of a procedure or service during post-op was A) planned prospectively, B) more extensive than original procedure or C) for therapy following a diagnostic surgical procedure.
  10. 59
    Distinct procedure service


    Indicates that a service was distinct or independent from other services performed on the same day
  11. 76
    Repeat procedure by same physician


    Used when a physician needs to indicate that a procedure or service was repeated subsequent to the original procedure or service
  12. 77
    Repeat procedure by another physician


    Used when a physician needs to indicate that a procedure or service preformed by another physician had to be repeated
  13. 78
    Return to the OR for a related procedure during the post-op period


    Used to indicate procedure was performed during the post-op period of the initial procedure
  14. 80
    Assistant surgeon


    Surgical assistant and/or physician assistant services
  15. 99
    Multiple modifiers


    Under certain circumstances, two or more modifiers may be necessary to completely describe a service
  16. AG
    Primary physician


    Used for primary surgery code performed on given DOS, each subsequent line should be billed with a mod 51
  17. AS
    Assistant surgeon


    Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant-at-surgery
  18. GA
    Medicare not covered, ABN (CMS R 131) obtained

    Used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or services as reasonable and necessary and they have on file an ABN signed by the beneficiary
  19. GV
    Attending physician not hospice physician


    Used when physician is providing terminal related care to a hospice patient but is not a hospice physician
  20. GW
    Service unrelated to terminal condition (Hospice)


    Used when physician see’s patient in a SNF or hospital setting and condition is not related to terminal condition
  21. GY
    Medicare non covered benefit


    Used when physicians, practitioners, or suppliers want to indicate that the item or services is statutorily non-covered or a is a Medicare benefit
  22. GZ
    Medicare not covered, no ABN (CMS R131)


    Used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or services as reasonable and necessary and they have not has an ABN signed by the beneficiary.
  23. LT
    Left side


    Used to identified procedures performed on the left side of the body
  24. QW
    Clia waived test


    Used when a lab test is performed in a clinical setting
  25. RT
    Right side


    Used to identified procedures performed on the right side of the body
  26. SW
    Services by certified diabetes educator


    Used when services is provided by a certified diabetes educator
  27. TC
    Technical component


    Certain procedures have both a professional and technical component
  28. ZS
    Medi-Cal Global charge for radiology


    Certain procedures have both a professional and technical component

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